Emerging imaging technologies are an important component of efforts to effectively detect and treat cancer. The American Recovery and Reinvestment Act of 2009 specifically targets the development of comparative effectiveness research (CER) to increase the performance and efficiency of the US health care system. This project will provide a national infrastructure for CER initiatives for advanced imaging in cancer. It will bring together the resources of Dartmouth Medical School, an established center of expertise in CER featuring pathbreaking investigations of geographic variability in medical practices at The Dartmouth Institute for Health Policy and Clinical Practice (TDI) and the Norris Cotton Cancer Center (NCCC);the American College of Radiology Imaging Network (ACRIN), which conducts rigorous clinical studies of advanced imaging technologies for cancer detection and treatment;and the Tufts Evidence-based Practice Center (EPC), which has specialized expertise in systematic review for diagnostic technologies. To achieve the full potential of these resources, we propose to develop a Center for Comparative Effectiveness Research in Cancer Imaging, a multi-institutional research center promoting and conducting cutting-edge comparative effectiveness research on advanced imaging in clinical cancer care. The Center will advance a research agenda and approaches for studying the impact of advanced imaging in cancer on health care utilization with attention to the consequences that significant incidental diagnostic findings have on patient care. Specific projects are proposed based on the National Lung Screening Trial, a major NCI-sponsored study, and the National Oncologic PET Registry, sponsored by the American College of Radiology and the Academy of Molecular Imaging. Specific aims are 1) establishing a Center for Comparative Effectiveness Research in Cancer Imaging to promote and support CER for imaging modalities, partnering with ACRIN and utilizing a new Dartmouth-based CER resource and research program;2) using the Center to advance methodologies that extend CER capacity for existing ACRIN projects while facilitating CER planning for future ACRIN trials;and 3) undertaking specific CER projects for PET that utilize the National Oncologic PET registry and Medicare administrative claims data. The multi-institutional collaborations on these aims involving TDI/NCCC at Dartmouth, the ACRIN statistical center at Brown, the National Oncologic PET Registry, and the Tufts EPC will rapidly advance comparative effectiveness research for imaging in cancer. PUBLIC HEALTH RELEVANCE: New imaging technologies for finding cancer and determining treatment are intended to improve the health of the US population. Research is needed to see if these technologies actually improve clinical care. Researchers representing several important institutions with unique resources will join forces to develop new studies of the effectiveness of advanced imaging in cancer.